Status:
Resolved
Health advisory:
160003
Date Issued:
02 Mar 2016
Issued by:
Roscoe Taylor, Acting Chief Health Officer, Victoria
Issued to:
Pathology services and medical practitioners

Key messages

From 4 April 2016 doctors and laboratories are required to notify the Department of Health and Human Services (DHHS) of:

  • all blood lead level test results greater than 5 micrograms per decilitre (replacing the current threshold of 10 micrograms per decilitre). You must provide notification to the DHHS in writing within five days of diagnosis.
  • all presumptive and confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). You must provide immediate notification by TELEPHONE upon initial diagnosis or suspicion.

What is the issue?

Pathology services and medical practitioners have an obligation to notify the Department of Health and Human Services of incidents of certain conditions as set out in the Public Health and Wellbeing Regulations 2009. These regulations have been updated, changing obligations of pathology services and medical practitioners, effective from 4 April 2016. Systems used to notify the department will be updated to reflect these changes from 4 April 2016. The department will be posting information about this change to pathology services and medical practitioners prior to 4 April.

Changes to blood lead level

Why make this change?

On 19 May 2015, the NHMRC released an updated Statement and Information Paper on the effects of lead on human health. It recommended that if a person has a blood lead level greater than five micrograms per decilitre, the source of exposure should be investigated and reduced, particularly if the person is a child or pregnant woman.

To ensure consistency with these latest recommendations, pathology services and medical practitioners will be required to notify the department about all blood lead levels greater than 5 µg/dL.

Lowering the blood lead level notification threshold to greater than 5 micrograms per decilitre will create more opportunities for early intervention for those at greatest risk of adverse health effects, and give rise to a better understanding of lead exposure in children.

This is a Group B notifiable condition requiring notification in writing within five days of diagnosis.

Who is at risk?

Based on notifications to the department (2011 -2014 inclusive) those at risk of lead exposure include:

  • People whose occupations involve lead exposure (90%)
  • People whose occupations do NOT involve lead exposure (10%), including:
    • Recreational shooters
    • Home renovators
    • People who make lead casts (usually for fishing)
    • People who use Ayurvedic medicines contaminated by lead.

While exposure to lead can be harmful to people of any age, the risk of health effects is highest for unborn babies, infants and young children.

What are the symptoms?

Symptoms are generally non-specific and may include constipation, colic, anaemia, headache, fatigue, restless legs and arms, tingling or prickling sensations in skin, myalgia and arthralgia, anorexia, sleep disturbance and difficulty concentrating. Encephalopathy or death can occur at blood lead levels of 100-120 micrograms per decilitre in adults and 70-100 micrograms per decilitre in children.

How is it diagnosed?

A blood lead test is the most reliable method for testing individuals for recent exposure to lead.

Measurement of blood lead should be considered when symptoms or health effects associated with lead are present and/or a source of lead exposure is suspected.

How are notifications acted on?

When the Department of Health and Human Services receives a non-occupational blood lead notification, officers in Environmental Health work together with medical practitioners and the affected individual and/or their family to identify the potential source/s of lead exposure and, if identified, evaluate the exposure and provide advice about strategies to safely manage this exposure.

The treating doctor has a critical role in providing advice about lead absorption and retesting the individual to ensure they are no longer exposed to the lead source/s.

In addition to responding to individual cases, the department uses blood lead notification data to monitor trends in lead exposure and inform policy responses or prevention activities related to elevated blood lead cases.

More information of blood lead levels

For health professionals

For consumers

Department contacts

  • Lead: Environmental Health - call 1300 761 874.
  • Notifications: Communicable Disease Prevention and Control Section - call 1300 651 160.

Addition of Middle East Respiratory Syndrome Coronavirus

Why make this change?

On 23 June 2015, the Commonwealth Government added Middle East Respiratory Syndrome Coronavirus (MERS-CoV) to the National Notifiable Diseases List. This came about as a result of a national review of preparedness, following continuing cases in Arabian Peninsula and the outbreak in the Republic of South Korea in May 2015.

Timely notification of MERS-CoV in Victoria will strengthen ongoing surveillance, and contact tracing activities for any future cases. This will ensure health professionals are effectively prepared to prevent an outbreak in Victoria.

This is a Group A notifiable condition, so requires immediate notification by TELEPHONE upon initial diagnosis or suspicion, followed by written notification within 5 days.

Who is at risk?

  • People who may have been exposed to MERS-CoV, through travel to a MERS-CoV -affected country, or contact with a confirmed case of MERS-CoV.
  • Of these people, older patients and those who are immunocompromised or have chronic diseases (such as diabetes, chronic lung disease or cancer) appear to be at greater risk of being severely affected by MERS-CoV disease.

What are the symptoms?

MERS-CoV infection can cause mild respiratory symptoms through to severe acute respiratory disease and death. Typical symptoms have included fever, cough, shortness of breath, and breathing difficulties. Pneumonia has been commonly reported, as have gastrointestinal symptoms including diarrhoea. Respiratory failure can occur with severe illness, requiring ventilator support.

How is it diagnosed?

The most appropriate test is an upper or lower respiratory tract sample for polymerase chain reaction (PCR) testing. Testing should only be carried out after discussion with the Communicable Disease Prevention and Control Section at the Department of Health and Human Services, and only where MERS-CoV is suspected on clinical and epidemiological grounds according to the case definition outlined in the most recent MERS-CoV CHO advisory. All testing for MERS-CoV in Victoria is carried out at the Victorian Infectious Diseases Laboratory (VIDRL).

How are notifications acted on?

When the Department of Health and Human Services receives a notification of a suspected case of MERS-CoV, our public health officers assist doctors in determining whether the case meets the case definition and is suitable for further testing. The Communicable Disease Prevention and Control Section is also able to assist with the public health management and contact tracing for any presumptive or confirmed cases.

In addition to responding to individual cases, the department uses MERS-CoV notification data to monitor trends in testing and to inform policy responses or prevention activities related to MERS-CoV.

More information on MERS-CoV

For health professionals

For consumers

Department contacts

  • MERS-CoV and Notifications: Communicable Disease Prevention and Control Section - call 1300 651 160.